Journal of general internal medicine
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Night float rotations, where residents admit patients to the hospital, are opportunities for practice-based learning. However, night float residents receive little feedback on their diagnostic and management reasoning, which limits learning. ⋯ Structured reflection and feedback during night float rotations is an opportunity to improve practice-based learning through lessons on disease progression, clinical reasoning, and communication.
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The Agency for Healthcare Research and Quality (AHRQ) could devote resources to collate and assess quality improvement studies to support learning health systems (LHS) but there is no reliable data on the consistency of data extraction for important criteria. ⋯ Creating explicit instructions for extracting data for quality improvement studies helps enhance the consistency of data extraction. This is important because it is difficult for LHS to vet these quality improvement studies on their own and they would value AHRQ's support in that regard.
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Unless implementation of systematic depression screening is associated with timely treatment, quality measures based on screening are unlikely to improve outcomes. ⋯ Implementing systematic depression screening within a large health care system led to high rates of screening and increased rates of depression diagnosis and treatment.
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Several population health big data projects have been initiated in the USA recently. These include the County Health Rankings & Roadmaps (CHR) initiated in 2010, the 500 Cities Project initiated in 2016, and the City Health Dashboard project initiated in 2017. Such projects provide data on a range of factors that determine health-such as socioeconomic factors, behavioral factors, health care access, and environmental factors-either at the county or city level. ⋯ Census Bureau. This resulted in a large extent of similarity among different datasets and a potential waste of resources. This perspective article aims to elaborate on the diminishing returns of creating more population health datasets and propose potential ways to integrate with clinical care and research, driving insights bidirectionally, and utilizing advanced analytical tools to improve value in population health big data.
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The learning and working environment for resident physicians shifted dramatically over the past two decades, with increased focus on work hours, resident wellness, and patient safety. Following two multi-center randomized trials comparing 16-h work limits for PGY-1 trainees to more flexible rules, the ACGME implemented new flexible work hours standards in 2017. ⋯ Although the majority of PDs support the ACGME 2017 work hours rules, only 25% of programs made immediate changes to extend hours. These data reveal that complex, often competing, forces influence PDs' decisions to change trainee schedules.